Coroner finds diving death accidental

The coroner’s report on the diving death of 23 year old Malaysian student Luqmanulhakim Bin Moien on April 28th, 2014 in Lake Puketirini, Huntly was released late last year. The coroner found the death to be accidental, but has asked for his recommendations arising from the event to be widely publicised.

The coroner said Mr Moien was a Malaysian learning to dive at a commercial diver training course being held at Lake Puketirini, Huntly, when he became separated from other in his group. He was seen breaking the water and in distress and not wearing his face mask or regulator. A search was commenced and Mr Moien was located on the lake bottom not breathing. He was brought to the shore of the lake. Emergency services had been notified. CPR was commenced immediately and continued until his death was declared by paramedics at the scene. The reason Mr Moien lost his mask and was not using his regulator could not be established. Testing showed that all of his diving equipment was in good functioning order. However the BCD used by Mr Moien was too large for his small frame and Mr Moien had placed too much weight on his weight belt.

These matters are likely to have exacerbated Mr Moien’s distress when he found himself in difficulty while submerged in the cold lake waters and zero visibility because of the large silt cloud. While Mr Moien was a recreational dive with some experience he was not experienced diving in these conditions. He died as a result of drowning and his death was found to be accidental.

The coroner said several issues in the case could easily occur on other diving training courses, resulting in the following recommendations for them:

  1. Assess the validity of students’ previous dive history and records
  2. Assess the site and if it suitable for the experience level of the students
  3. Assess the students’ abilities. Is the student capable of the dive? Is the student able to recover themselves unassisted if the need arises?
  4. Plan for the ability to abort the dive if the situation changes rapidly.
  5. Highlight the importance of regular buoyancy checks. Do not rely on students to continually monitor their weight.
  6. Dive with a source of light (torch, chemical glow stick) in low light level conditions.
  7. Always carry some form of cutting implement that is easily reachable in an emergency
  8. All divers to carry a watch or timing device on all dives
  9. Ensure communication equipment is utilised at all times
  10. Ensure lifelines or float lines are used when possible, unless risk of entanglement makes it impractical
  11. Training facility to adhere to the correct standards (AS/NZS2299)
  12. Ensure duties and roles (Diver, Diver’s Attendant, Standby Diver, Supervisor, Assessor, Instructor, are clearly assigned and adhered to
  13. Whenever possible reduce the ratio of student divers. If only one diver needs to conduct a dive then conduct a dive with one student only
  14. Ensure all students are familiar with the operation of all equipment.

For the full Coroner’s report go to: https://tinyurl.com/y9mf7te7

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